Sexual function in men with epilepsy: how important is testosterone?

OBJECTIVE: To ascertain the effects on sexual function of men with epilepsy (MWE) of testosterone levels and indices of anxiety and depression. METHODS: Sixty MWE taking one antiepileptic drug only (AED), with no comedication, were compared with 60 control men. Total testosterone (TT), free testosterone (FT), bioactive testosterone (BAT), dehydroepiandrosterone sulfate (DHEAS), androstenedione, and sex hormone-binding globulin (SHBG) were measured. Each man also completed validated questionnaires exploring sexual desire (Sexual Desire Inventory [SDI]), sexual response (Sexual Response Inventory [SRI]), erectile function (Sexual Self-Efficacy Scale [SSES]), and anxiety and depression (Hospital Anxiety and Depression Scale). RESULTS: MWE reported lower levels of sexual desire and lower erectile function compared with controls. They had significantly higher levels of anxiety, depression, and psychological distress. MWE had significantly higher SHBG levels and significantly lower DHEAS. There were no significant differences between the groups' TT, FT, or BAT levels. BAT levels were significantly lower in men taking enzyme-inducing AEDs than in those taking non-enzyme-inducing AEDs. Visual inspection of TT and BAT levels showed that the majority of MWE and controls had TT and BAT levels above the "androgen threshold" levels of 12 nmol/L TT or 3.8 nmol/L BAT considered necessary for normal sexual function. There was a significant correlation (Spearman rank and simple linear regression) between sexual function and indices of anxiety and depression. There was no significant relationship between SDI and SSES and TT, FT, or BAT (Spearman rank correlation). CONCLUSIONS: Concentrating on hormone levels alone as an explanation of sexual dysfunction in epilepsy represents an overly simplistic approach to the problem. Future studies should include measures of quality of life, anxiety, and depression.

Evolution of an international external quality assurance model to support laboratory investigation of Streptococcus pneumoniae, developed for the SIREVA project in Latin America, from 1993 to 2005.

In 1993 the Pan American Health Organization initiated a laboratory-based surveillance system, called the SIREVA project, to learn about Streptococcus pneumoniae invasive disease in Latin American children. In 1994, National Laboratories in six countries were trained to perform serotyping and antibiotic susceptibility testing using broth microdilution to determine the MIC for specified antibiotics. An international External Quality Assurance (EQA) program was developed to monitor and support ongoing laboratory performance. The EQA program was coordinated by the National Centre for Streptococcus (NCS), Edmonton, Canada, and included external proficiency testing (EPT) and a validation process requiring regular submission of a sample of isolates from each laboratory to the NCS for verification of the serotype and MIC. In 1999, the EQA program was decentralized to use three of the original laboratories as regional quality control centers to address operational concerns and to accommodate the growth of the laboratory network to more than 20 countries including the Caribbean region. The overall EPT serotyping accuracies for phase I (1993 to 1998) and phase II (1999 to 2005) were 88.0 and 93.8%, respectively; the MIC correlations within +/-1 log(2) dilution of the expected result were 83.0 and 91.0% and the interpretive category agreements were 89.1 and 95.3%. Overall, the validation process serotyping accuracies for phases I and II were 81.9 and 88.1%, respectively, 80.4 and 90.5% for MIC agreement, and 85.8 and 94.3% for category agreement. These results indicate a high level of testing accuracy in participating National Laboratories and a sustained increase in EQA participation in Latin America and the Caribbean.

Sublethal injury and resuscitation of Candida albicans after amphotericin B treatment.

Amphotericin B treatment was previously shown to inhibit Candida albicans reproduction and reduce the fluorescence of vitality-specific dyes without causing a corresponding increase in the fluorescence of the mortality-specific dyes bis-(1,3-dibutylbarbituric acid)trimethine oxonol and SYBR Green I. In the present study, we have confirmed these results and have shown that the numbers of CFU are reduced by 99.9% by treatment with 0.5 micro g of amphotericin B per ml for 10 h at 35 degrees C. This reduction was not due to fungal cell death. First, the level of reduction of the tetrazolium salt 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide increased in the presence of concentrations of amphotericin B that caused greater than 90% reductions in the numbers of CFU. Second, fungal cells treated with amphotericin B at a concentration of 0.5 micro g/ml were resuscitated by further incubation at 22 degrees C for 15 h in the continued presence of amphotericin B. Third, recovery of the ability to replicate was prevented by sequential treatment with 20 micro g of miconazole per ml, which also increased the fluorescence of mortality-specific dyes to near the maximal levels achieved with 0.9 micro g of amphotericin B per ml. Sequential treatment with fluconazole and flucytosine did not increase the levels of staining with the mortality-specific dyes. Itraconazole was less effective than ketoconazole, which was less effective than miconazole. The practice of equating the loss of the capacity of C. albicans to form colonies with fungal cell death may give incorrect results in assays with amphotericin B, and the results of assays with caution with other antifungal agents that are lipophilic or that possess significant postantifungal effects may need to be interpreted.

M types of group a streptococcal isolates submitted to the National Centre for Streptococcus (Canada) from 1993 to 1999.

The National Centre for Streptococcus (NCS) (Canada) determined the group A streptococcal (GAS) M types of 4,760 Canadian isolates submitted between 1993 and 1999 by classic serotyping. The 10 most frequently identified M types were M1 (26.4%), M12 (9.8%), M28 (8.9%), M3 (6.8%), M4 (6.2%), M11 (4.8%), M89 (3.1%), M6 (3.0%), M2 (2.6%), and M77 (1.9%). Nontypeable isolates accounted for 15.4% of the collection. The province of Ontario submitted 51.1% of the isolates, followed by Quebec (21.2%) and Alberta (13.9%). Together, these three provinces constituted 71.3% of the Canadian population in 1996. The numbers of M types M1, M12, M28, and M3 occurred most frequently in subjects whose ages were <1 to 15 years and 25 to 45 years, as well as in the elderly (60 to 90 years). Further analysis found that the four most frequently identified M types from blood, brain, and cerebrospinal fluid were M1 (28.2%), M28 (9.2%), M12 (9.1%), and M3 (8.2%), with 13.4% of isolates being nontypeable. The four isolates from throats most frequently identified were M1 (19.5%), M12 (15.3%), M3 (8.6%), and M28 (5%) with 19.4% of isolates being nontypeable. The sic gene of a subset of M1 strains (9.5% of the M1 collection) was sequenced. Of 36 sic types identified, the four most common were sic1.01 (22.8%), sic1.02 (14.9%), sic1.135 (10.5%), and sic1.178 (9.6%). Together these four sic types further characterized nearly 60% of the M1 strains sequenced. In summary, from the years 1993 to 1999, the NCS detected 54 M types, of which 10 different M types constituted 73.5% of the collection. M1 was the most common GAS M type circulating in the Canadian population, responsible for more than a quarter of the isolates typed. The most common throat isolates differed in M-type and proportion from those of invasive isolates. Sequencing the sic gene further characterized the most common M-type serotype 1 in a fashion that may be useful for epidemiologic investigations.

Comparative evaluation of a new fluorescent carboxyfluorescein diacetate-modified microdilution method for antifungal susceptibility testing of Candida albicans isolates.

This report presents a fluorescent carboxyfluorescein diacetate (CFDA)-modified microdilution method used for the susceptibility testing of Candida albicans to amphotericin B, fluconazole, ketoconazole, itraconazole, voriconazole, and flucytosine. Four different broth microdilution susceptibility testing methods were simultaneously evaluated at 24 and 48 h. The MICs determined using the CFDA-modified method (MIC(cfda)) were compared to those obtained by the standard broth microdilution method (MIC(visual)) and a procedure employing the indicator Alamar blue (MIC(alamar)). The reference MIC was determined visually as recommended by the NCCLS M27-A protocol, and then quantified spectrophotometrically following agitation (MIC(spec)). The CFDA-modified microdilution method was demonstrated to effectively determine the MICs for all the antifungal drugs tested at both 24 and 48 h. The results from both the MIC(spec) and MIC(cfda) methods yielded >80% agreement within +/-1 dilution and >90% agreement within +/-2 dilutions at 24 h in comparison to the reference MIC(visual) method, respectively. The trailing growth phenomenon that occurs with azole antifungal drugs and many strains of C. albicans did not inhibit the effectiveness of the MIC(spec) and MIC(cfda) methods. The MIC(spec) and MIC(cfda) methods shared 92.8% agreement within +/-1 dilution at 24 h and 87.6% agreement within +/-1 dilution at 48 h.

Outbreak of Neisseria meningitidis, Edmonton, Alberta, Canada.

From December 1999 to April 2001, the greater Edmonton region had 61 cases of invasive meningococcal infection, two fatal. The outbreak was due to Neisseria meningitidis serogroup C, electrophoretic type 15, serotype 2a. Analysis of the strains showed that 50 of 56 culture-confirmed cases were due to a single clone and close relatives of this clone. This strain had not been previously identified in the province of Alberta dating back to January 1997.

Susceptibility of human isolates of Salmonella typhimurium DT 104 to antimicrobial agents used in human and veterinary medicine.

Multiple antibiotic resistance is frequently observed among strains of Salmonella typhimurium DT104. We examined the antibiotic resistance patterns of 240 human isolates submitted from central and northern Alberta to our laboratory for confirmatory testing during 1996-1999. Broth microdilution MIC panels included antibiotics proposed by the Canadian National Enteric Disease Surveillance Committee for human and animal isolates. Seven different susceptibility patterns were observed. The two most common patterns accounted for 83% of isolates; 48% were susceptible to all antibiotics tested and 35% were resistant to ampicillin, tetracycline, chloramphenicol and amoxicillin-clavulanate. All strains were susceptible to enrofloxacin and trovafloxacin with variable resistance to kanamycin and chloramphenicol. There were more susceptible isolates observed in 1996 and 1997 than in 1998 and 1999, but multiple resistant isolates were found throughout the study period.

Fatal group a streptococcal toxic shock-like syndrome in a child with varicella: report of the first well documented case with detection of the genetic sequences that code for exotoxins SPE A and B, in Sao Paulo, Brazil

Crianca de sete anos, previamente higida, foi admitida na unidade de terapia intensiva por quadro de toxemia associado a varicela. Evoluiu rapidamente para choque e insuficiencia de multiplos orgaos e sistemas e, apesar do tratamento intensivo, morreu no quarto dia apos a admissao. A cultura de secrecao colhida por puncao profunda de partes moles em regiao toracica foi positiva para Streptococcus pyogenes, proteina-M nao tipavel e carreador dos genes codificadores da producao de exotoxinas pirogenicas estreptococicas A e B, preenchendo os criterios para definicao de Sindrome do choque toxico estreptococico. Os autores discutem aspectos clinicos e fisiopatologicos desta sindrome, bem como alguns aspectos incomuns relacionados a este caso